North East region’s NHS changing gluten-free prescribing arrangements

NHS commissioners across the North East will take steps to update and rationalise their arrangements for prescribing gluten-free foods.

 

Gluten-free foods are provided on prescription to patients who have Coeliac disease, as this prevents their immune system reacting to gluten. In addition to commercially-produced or prescribed products, a number of foods are naturally gluten-free, such as potatoes, rice and some noodles.

 

Dr Graham Syers, Chair of the North East and North Cumbria CCG Prescribing Forum, said: “The system for prescribing gluten-free foods on prescription was introduced in the late 1960s, but what was appropriate in 1968 is not necessarily appropriate in 2017.

 

“The range and price of gluten free products available in supermarkets has improved dramatically, and many items like pizzas and pasta are similar in price to gluten-containing equivalents.

 

“Given that the NHS does not prescribe specialist foods for other conditions, such as diabetes, it is only fair to take a careful look at our policy on gluten-free foods.

 

“Some specialist gluten-free products, like bread and flour, do still cost more, so we intend to concentrate our funding on these in the future, to try and help Coeliac patients keep their weekly food bills broadly in line with the average.

 

“With the NHS strongly committed to encouraging healthy eating, it no longer makes sense to provide items like cakes or biscuits, which in any case are easier and cheaper to buy in supermarkets than used to be the case.”

 

Around £25 million is spent on gluten-free foods every year by the NHS nationally. Many areas have already reviewed their prescribing policies and made changes in recent years.

 

The new policy, which is already in place in Northumberland and North Tyneside, will be adopted in the summer by the other eight Clinical Commissioning Groups in the region. There is a national consultation underway and the policy may need to be adapted depending on the outcome of the national consultation.

 

 

What gluten-free products will be available on prescription in future?
Age group New recommendation (per month)
Male 19-59 years  

8 x 400g bread (or 4 x 500g mix suitable for making bread)

60-74 years
75+ years
Female 19-74 years 8 x 400g bread (or 4 x 500g mix suitable for making bread)
75+ years 6 x 400g bread (or 3 x 500g mix suitable for making bread)
Add 4 units if breastfeeding; or one unit if in the third trimester of pregnancy
Child 1-3 years 6 x 400g bread (or 3 x 500g mix suitable for making bread)
4-6 years
7-18 years 8 x 400g bread (or 4 x 500g mix suitable for making bread)

 

 

Note to reporters: below we have added some questions and answers, which you may find helpful:

 

Why are you prescribing only bread and flour?

The decision was taken to fund bread as bread is considered to be a staple food in the UK and the gluten-free breads are more costly than the gluten-containing equivalents in the supermarkets. The addition of flour (including multipurpose flour and bread mixes) allows people to cook or bake other foods. This is in line with national guidelines.

 

Why are only some brands of bread and flour included?

We have included all brands that are available as a stock item to local pharmacies from the majority of local wholesalers without restrictions on minimum order. We have excluded products that have additional administration charges, delivery or other charges added to the list price as these costs will be incurred by the NHS and mean that the single products end up being significantly more expensive to the NHS than if they were purchased from a supermarket.

 

Why can’t I get my gluten-free products from the supermarket on prescription?

It would be nice if we could do this – unfortunately the way the NHS works means that only pharmacies or dispensing doctors’ practices are able to dispense NHS prescriptions.

 

Why are you no longer funding biscuits, cakes, etc.?

It is generally accepted that these products are treats and not part of an everyday healthy diet. To prescribe items on the NHS considered treats would be at odds with national healthy eating messages.

 

Why are you not funding pizza bases and pasta on prescription anymore?

There are various naturally gluten-free foods that can be eaten in place of pasta, such as potatoes, rice, rice noodles, etc. Also gluten-free pizza bases and pasta are available from supermarkets at a reasonable cost and are similarly priced to the equivalent gluten-containing products.

 

Cost of gluten-free products to the NHS

Gluten-free products are more expensive than gluten-containing products but it is still unclear why the NHS is charged so much for gluten-free products. There is no obvious reason why items available on prescription cost more than double the supermarket price of similar items.

 

Why have you focused on gluten-free foods?

The NHS has always had to make decisions on the fairest way to spend its resources, and it is important to recognise that conditions have changed substantially since these products were first prescribed in the 1960s. We will continue to provide support with the aim of ensuring that weekly food bills remain broadly comparable with the average spend for non-coeliacs.

 

It is common for there to be some level of restriction on the range of items that can be supplied under the NHS. Examples of other areas where this applies include the provision of synthetic wigs (but not real‑hair wigs), dentures, crowns and bridges (but not dental implants), basic spectacle frames (but not necessarily the most fashionable ones).

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